Pace and determinants of implementation of the self-management of well-being group intervention: a multilevel observational study

Abstract

Abstract Background When implementing an empirically supported intervention (ESI) arrays of influencing factors operate on the professional and organizational level, but so far dependency between these levels has often been ignored. The aim of this study is to describe the pace and identify determinants of implementation of the Self-Management of Well-being (SMW) group intervention while taking the dependency between professionals and organizations into account. Methods Pace of implementation was measured as the time between training of professionals and first use of the SMW intervention in months. Determinants of first use were derived from the Fleuren framework and assessed using web-based questionnaires and telephone interviews. First, univariate analyses, Fisher’s exact tests and t-tests, were performed to identify determinants of first use of the SMW intervention on the individual professional and the organizational level independently. Second, multilevel analyses were performed to correct for the dependency between professionals and organizations. Simple multilevel logistic regression analyses were performed with determinants found significant in the univariate analyses as independent variables, first use as dependent variable, professionals entered in the first level, and organizations in the second level. Results Forty-eight professionals from 18 organizations were trained to execute the SMW intervention. Thirty-two professionals achieved first use, at a mean pace of 7.5 months ± 4.2. Determinants on the professional level were ‘ownership’, ‘relative advantage’, ‘support from colleagues’ and ‘compatibility’. Determinants on the organizational level were ‘organizational size’ and ‘innovation-task orientation fit’. Multilevel analysis showed that ‘compatibility’, a factor on the professional level, was the only significant determinant contributing to first use in the multilevel model. Conclusions This implementation study revealed a strong dependency between professionals and organizations. Results showed that a majority of professionals used the SMW intervention in about 8 months. When the dependency between professionals and organization was taken into account, the professionals’ perception of compatibility was the only remaining determinant of implementation on the professional level. Organizational size and managers’ perception of ‘innovation-task orientation fit’ were determinants of implementation on the organizational level. It is advisable to discuss the compatibility between new and current tasks among managers and professionals before adopting a new intervention.

Keywords

• Pace
• Implementation
• Determinants
• Health care
• Multilevel-analysis
• Older adults